Abstract

The most up-to-date estimates demonstrate very heterogeneous spread of HIV-1, and more than 30 million people are now living with HIV-1 infection, most of them in sub-Saharan Africa. The efficiency of transmission of HIV-1 depends primarily on the concentration of the virus in the infectious host. Although treatment with antiviral agents has proven a very effective way to improve the health and survival of infected individuals, as we discuss here, the epidemic will continue to grow unless greatly improved prevention strategies can be developed and implemented. No prophylactic vaccine is on the horizon. However, several behavioral and structural strategies have made a difference — male circumcision provides substantial protection from sexually transmitted diseases, including HIV-1, and the application of antiretroviral agents for prevention holds great promise.

Authors

Figure 4

Prevention efforts can be divided into four broad categories: those offered to HIV-1–negative subjects, especially those in high-risk groups (e.g., the offer of male circumcision, condoms); those offered to people with a strong likelihood of recent exposure to HIV-1 (e.g., topical microbicides, antiretroviral preexposure prophylaxis [PrEP]); those offered shortly after exposure (e.g., postexposure prophylaxis [PEP]), and those offered to people who are already infected (secondary prevention; e.g., the use of antiretroviral therapy to reduce viral load).